We've had a problem lately with voice orders. This doc has said, "that is not what I ordered", leaving the nurse to hang. Luckily, up to now, more than one nurse has heard what he has said (speaks rapidly, so quietly that it really appears to be his way of challenging our nurses about how close their attention is paid to Him-with-a-capitol-H).
We have started just handing him an order sheet and asking him to write (atrocious legibility as well) his orders, and if we can't read them, we ask him to rewrite them himself. I also think his telephone orders should be heard by 2 RN's, but this is logistically difficult many times.
We chart carefully on all patient's subjective comments, descriptions of how they are doing, etc. because he likes to come unglued about no BM for 3 days, poor sleep, noise in the hallway, the clock not keeping perfect time.....you get the picture. We state carefully, "patient refused enema this a.m., even after encouragement and education about why bowels can be a bit slower during hospitalization. Request for MOM or suppository not responded to by physician", or "Standing orders not signed by physician at time of admit, so will leave him a message about need for sleeper".
I don't like "nurse defensively", but it seems indicated in a time of not just stressful workplaces, but anxiety-filled workplaces.
Be careful out there!